QuestionHi Dr. Ramirez,
I'm a 32 y/o with no history of pregnancies.
For the past several years I've had lots of pain and symptoms from my rectum, which always correlated with the timing of my period. I went to several doctors who had no time for my symptoms, chalked it up to normal periods, recommended pain relievers, and sent me on my way. As years went by, and the symptoms got more and more unbearable,I knew what I was experiencing was not normal.
After a colonoscopy in Jan 2011, biopsies showed endometrial cells in my colon. I managed to keep it under control by taking birth control pills, three months at a time. Since I wasn't getting my period as often, the pain was much more manageable. However, I went off the pill in Dec 2011 because my partner and I decided to start trying for a family. (He already has a 6 y/o from a previous marriage.)
From February to May, I was seeing a fertility acupuncturist in the hopes that he could help speed things along. Although he wasn't able to remove the endo problems, I felt like he did help me manage the pain better.
Three months ago, I ended up going in for a laparoscopy. My surgeons did a cystectomy on the left ovary, removed endometriosis adhesions from the uterosacral ligaments, removed a golf ball sized endometrioma that was growing on my colon, and also performed a 6-inch bowel resection. The surgery went without problems and there seemed to be no reason for a delay in healing. I think highly of my doctors and felt hopeful that this surgery would get me in tiptop shape.
Since the surgery, I've still experienced some of the same symptoms as before. It's very disheartening and frustrating to be so "fresh" from surgery and already experiencing the same beginnings of what I felt before. The rectal pain is gone, however I am continuing to pass blood and lining rectally, along with my period. My doctor tells me that things are still healing and not to worry. However, I can't help but worry that things are not right and I'm wasting valuable time. What do you think?
In addition, I've also started taking Clomid 50. Previous to my surgery, I had taken it for two cycles. The first one went off without a hitch. The second resulted in a horribly painful cyst rupture. I'm worried now that the Clomid may encourage the endometrial growth. Am I being too anxious? Is this not really something to be concerned with? My goal at this point is to get pregnant as soon as possible, so I can stop leaving my body susceptible to endo.
Lastly, I recently lost my job and health insurance. Which means my visits to the doctors' offices are very limited. Do you have any advice on the steps/ paths I should be taking?
I am at a complete loss of what to be doing at this point. It feels like I'm fighting a losing battle with my own body.
Thank you so much for your help,
Feeling Hopeless in California
AnswerHello Reader from the U.S. (California),
You have stage 4 endometriosis and this has been shown to impede pregnancy by natural methods such as natural intercourse, ovulation induction with intercourse using Clomid, Femara or injectables or insemination (IUI). This is thought to be because the endometriosis causes a subclinical inflammatory reaction in the pelvis which kills or injures the egg at the time of ovulation or impedes the egg from getting to the tube. Therefore, the natural treatment methods, such as the Clomid you are using, are NOT recommended.
Unfortunately, the ideal and recommended treatment with stage 4 endometriosis is IVF. Fortunately, you are only 32 years old and your IVF success rates will be high for a long time. So, if you can't afford IVF now (most insurance in California do not cover IVF#, then you have time to save your money for that purpose. You will need to save a minimum of $20,000 to cover the IVF, meds, lab tests and possible a second cycle.
Definitely, getting pregnant is a good treatment for endometriosis and it has been shown to put endometriosis in remission #probably because of the body changes, lack of period for almost two years and anti-estrogenic effects on the endometriosis#. You are in a category where the only doctor you should be seeing about getting pregnant is an infertility sub-specialist #one that does IVF as well as other treatments) and NOT a general Ob/Gyn. There is nothing that a general Ob/Gyn can do to help you get pregnant.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate
